| NPI | 1285881276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5004047) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 183468) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2012-11-16 |